In Reply We concur with Dr Hehir and colleagues that a wide range of clinicians can provide high-quality, patient-centered, prenatal genetic counseling and that women considering invasive diagnostic testing usually meet with a trained professional to discuss risks and benefits prior to providing informed consent. However, because most pregnant women do not undergo invasive testing, they do not meet with such specialists.
More commonly, women receive brief explanations of aneuploidy screening during their first or second prenatal visit, with little time to engage in nuanced shared decision making. We believe that such women could benefit from better information on their options and an opportunity to clarify their values, and that a decision-support guide can help ensure more informed decision making. Our intention was not to suggest that a computerized decision-support guide should replace genetic counseling. Rather, our goal was to gain an understanding of the decisions women from a range of sociodemographic backgrounds would make if they were fully informed about screening and testing options, their voluntary nature, and their potential outcomes, and did not face financial barriers to testing.